The primary goal of Project #2 is to evaluate the long-term outcomes in brain function/structure of two[unreadable] groups of VLBW infants (<1300 g) with anemia of prematurity, who were randomly assigned to either a[unreadable] restrictive or liberal RBC transfusion protocol as part of a previous PPG project. Our aim is to determine[unreadable] whether different RBC transfusion guidelines result in different long-term (at age 13)[unreadable] neurodevelopmental outcomes. Our general hypotheses are: 1) Preterm groups will show structural[unreadable] abnormalities of frontal, prefrontal, hippocampal, cerebellar and white matter brain regions, with the[unreadable] restricted transfusion group showing greater abnormalities. 2) Neuropsychological deficits will be[unreadable] identified in both preterm groups in functions governed by fronto-striatal circuits such as rapid naming,[unreadable] verbal fluency, working memory, fine-motor dexterity, and attention. 3) There will be a relationship[unreadable] between documented brain abnormalities and cognitive deficits. We will accomplish our goal by[unreadable] comparing these two groups at age 13, as well as a matched healthy term control group, on[unreadable] neuropsychological functions and brain structure (MRI). The hypotheses of Project #2 are based on the[unreadable] concept that more restrictive transfusion criteria may decrease the oxygen available to the developing[unreadable] brain and could result in more apnea and hypoxia or create iron depletion, either of which could result[unreadable] in impaired neurodevelopment. The specific neuropsychological functions and brain structures that will[unreadable] be addressed in this study have been selected as those most likely to be impaired by limited brain[unreadable] oxygen delivery or brain iron depletion, either of which could be due to restrictive transfusion criteria or[unreadable] to poorly understood adverse effects of multiple transfusions. This project allows the evaluation of[unreadable] strategies for transfusion management of anemia, which is central to the overall PPG theme. Our[unreadable] specific hypotheses are that more restrictive criteria for transfusion will lead to greater structural[unreadable] abnormalities in specific regions of the brain including frontal-prefrontal cortex, basal ganglia, and[unreadable] hippocampus and cerebellum. These abnormalities will affect functions such as rapid naming, verbal[unreadable] fluency, memory, fine- and gross-motor dexterity, attention and executive functions. More restrictive[unreadable] criteria will also lead to greater behavioral inhibition due to frontalstriatal deficits; but will not lead to[unreadable] differences in more general functions such as language, visual-spatial skills, long-term memory,[unreadable] intelligence, and academic achievement. The study proposed is timely because all of the children will[unreadable] be 13 years old during this study period, allowing examination of long-term effects of the transfusion[unreadable] practices. It is also timely in light of the continuing controversy regarding the most appropriate RBC[unreadable] transfusion guidelines to be used to treat anemia of prematurity. The long-term neuropsychological and[unreadable] brain imaging follow-up of premature anemic infants receiving different transfusion management criteria[unreadable] has never before been examined. This study will provide important findings related to potential adverse[unreadable] effects of transfusion practices on neurodevelopment.